Clinical Effectiveness of Telemedicine in Diabetes Mellitus: A Meta-Analysis of 42 Randomized Controlled Trials

Abstract

Background:Telemedicine is instrumental in improving diabetes patient care, as well as providing significant cost benefits. This meta-analysis was conducted to compare the effectiveness of telemedicine intervention with usual care in diabetes patients.Methods:Randomized controlled trials (RCTs) reporting a change in HbA1c after usual care and telemedicine intervention were retrieved from electronic databases.Results:Data on 6,170 participants (mean age 13.3 to 71.0 years), with 3,128 randomized to usual care and 3,042 to telemedicine intervention, were retrieved from 42 RCTs. Eight studies used teleconsultation, while 34 used telemonitoring (device based). Nine studies enrolled both type 1 and type 2 diabetes patients, 21 focused on type 2 diabetes patients, and 12 on type 1 diabetes patients. The mean reduction in HbA1c was significantly higher in the telemedicine groups (Hedges' g = -0.37, p < 0.001). Type 2 diabetes patients experienced a higher reduction in HbA1c compared to type 1 diabetes patients (Hedges' g = -0.48, p < 0.001 vs. -0.26, p < 0.05; Q = 1935.75, p < 0.0001). Older patients (41-50 years, Hedges' g = -1.82, p < 0.001; >50 years, Hedges' g = -1.05, p < 0.001) benefited more than their younger counterparts (Hedges' g = -0.84, p = 0.07). Telemedicine programs lasting >6 months produced a significantly greater reduction in HbA1c levels (Hedges' g = -2.24 vs. -0.66, p < 0.001).Conclusion:Telemedicine interventions are more effective than usual care in managing diabetes, especially type 2 diabetes. Furthermore, older patients and a longer duration of intervention provide superior results.